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Trends in the PAF of stroke DALYs due to risk factors, for both sexes, 1990-2021 Data in parentheses are 95% uncertainty intervals. DALYs=disability-adjusted life-years. PAF=population attributable fraction.
Source publication
Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. We estimated incidence, prevalence, death, and disability-adjusted life-year (...
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Background
Stroke remains a significant global health challenge, with persistent disparities in burden across different countries and regions. This study aimed to assess the temporal trends in cross-country inequalities of stroke and its subtypes burden from 1990 to 2021.
Methods
We conducted a secondary analysis of the Global Burden of Diseases,...
Background
HIV/AIDS persists as a global health challenge despite significant advancements in antiretroviral therapy (ART). The transformation of HIV into a chronic condition, coupled with regional disparities and evolving epidemiological trends, necessitates an updated analysis of the disease burden.
Methods
We conducted a comprehensive analysis...
Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021.
Methods: We estimated incidence, prevalence, death, and disabilit...
Background and Purpose
The aim of this study was to assess the intracerebral hemorrhage (ICH) burden in 204 countries and territories worldwide from 1990 to 2021, disaggregated by sex, age, and sociodemographic index (SDI) at the global, regional, and country levels.
Methods
Data from the 2021 Global Burden of Disease Study (GBD) were used to calc...
Background
Air fine particulate matter and tobacco smoke exposure are primary risk factors for lung cancer. However, their recent global exposure levels, attributable burden, and patterns of inequalities remain insufficiently quantified.
Methods
Utilizing the Global Burden of Disease 2021 study, we analyzed exposure levels of air fine particulate...
Citations
... We assessed their percentage contributions to childhood stroke DALYs in 2021. These risk factors were previously defined [1]. ...
Background
Stroke in children is a global epidemic.
Methods
Data on stroke, including incidence, DALYs, mortality, and associated risk factors from 1990 to 2021, were obtained from the Global Burden of Disease (GBD) study, 2021. Estimated annual percentage changes were calculated to evaluate changes in the age‐standardized rates of incidence (ASIR), DALYs (ASDR), and mortality (ASMR), as well as trends by age, sex, and sociodemographic index (SDI). Projections of DALYs to 2050 were made.
Results
In 2021, there were 310,133 incident stroke cases, accounting for 24,807 deaths and 2,414,655 DALYs among children and adolescents. The global ASIR, ASDR, and ASMR for stroke were 11.8, 93.9, and 1.0 per 100,000 population, respectively. Middle‐to‐low‐SDI regions accounted for 81.6% of incident cases, 90.2% of DALYs, and 92.7% of deaths. A reversed V‐shaped association was observed between SDI and ASRs. Children < 1 year had the highest ASRs, with rates generally decreasing with age, and the highest incidence of hemorrhagic stroke. Adolescents aged 15–19 years had the highest incidence of ischemic stroke. Non‐optimal temperature contributed the most to the DALYs and death rates for stroke. By 2050, it is projected that 282,404 DALYs will be lost due to stroke.
Conclusions
Stroke burden varies by the GBD region, country, age, sex, and SDI. Despite declines in ASRs, stroke remains a significant burden, especially in middle‐to‐low‐SDI regions, among children < 1 year, and among those with intracerebral hemorrhage. Non‐optimal temperature emerges as the leading modifiable risk factor for children stroke; targeted interventions can prevent this.
... With 1.25 million new stroke cases, India made up 10 per cent of the global burden in 2021. 1 Stroke survivors frequently endure high levels of perceived stress, adversely affecting their rehabilitation and quality of life. Stroke can be a life-changing event, with survivors frequently experiencing some level of disability, reduced independence, and an abrupt lifestyle change. ...
Background: The global incidence of stroke reached 11.9 million cases in 2021, a 70% rise since 1990, with India contributing 1.25 million new cases, or 10% of the global burden. High perceived stress levels among stroke survivors negatively impact rehabilitation outcomes and quality of life. Methods: His randomized controlled trial employed a quantitative pre-test post-test control group design. Conducted in the Thrissur District, Kerala, the study enrolled 60 stroke patients, selected via simple random sampling. A multi-intervention program, including Benson’s relaxation therapy and counseling, was administered to the experimental group. Perceived stress levels were reassessed after one month. Results: After one month, the experimental group demonstrated a 78.77% reduction in perceived stress (pre-test mean score = 70.40, post-test mean score = 14.93), compared to the control group, which showed no significant change. Statistical analysis confirmed a significant decrease in perceived stress across time points in the experimental group (p<0.001) but not in the control group (p=0.700). Conclusion: The multi-intervention program significantly reduced perceived stress among stroke patients, underscoring the value of combining physical and psychological rehabilitation strategies for improved recovery outcomes.
... Globally, the prevalence of stroke is also rising. According to the Global Burden of Disease Study, in 2021, there were more than 101 million people living with the consequences of stroke worldwide, with a global prevalence rate of approximately 1.26% [5]. However, some regions of Europe report significantly higher prevalence rates, reaching up to 9.2% in older populations [6]. ...
Unlabelled:
Stroke is a cerebrovascular syndrome due to a sudden interruption of blood flow to the brain that causes transient or permanent damage. Despite advances in the field of medical science, stroke is still common and continues to have a significant effect on quality of life.
Objective:
The objective of the study was to analyze the prevalence of strokes in Spain, considering differences in sociodemographic factors, functional limitations, and access to rehabilitation, with special attention to sex-related disparities.
Methodology:
A cross-sectional study was conducted using data from the latest European Health Survey in Spain carried out between 2019 and 2020 on a total of 22,072 people. Individuals over 16 years of age with a medical diagnosis of stroke were selected for this study. Sociodemographic variables, self-perception of health, limitations in daily activities, level of physical activity, and access to rehabilitation treatment were analyzed. Descriptive measures and inferential tests were applied for statistical analysis.
Results:
The prevalence of strokes occurring in Spain was estimated at 2.02%, which is lower than European figures. Men tend to have strokes at younger ages (50% between 36 and 73 years), while women report a poorer quality of life after the incident. Most patients had not received rehabilitation services in the last year.
Conclusions:
Given the aging population, it is essential to reinforce prevention, early detection and rehabilitation therapies to improve quality of life and reduce the burden of care.
... Acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability worldwide [1]. Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) for large vessel occlusion (LVO) are established treatments that significantly improve outcomes in eligible patients [2]. ...
Background
Tenecteplase (TNK) offers promising efficacy and safety data for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) and pharmacological advantages over alteplase (rt-PA), justifying its gradual adoption as primary thrombolytic agent. At our tertiary care center, we transitioned from rt-PA to TNK, providing valuable real-world insights into this process, including its use beyond the 4.5-hour time window.
Methods
We retrospectively analyzed our stroke registry to compare clinical and procedural data from AIS patients treated with rt-PA (up to 6 months before transition) and those treated with TNK (up to 6 months after transition, starting June 2024). Primary endpoints included treatment metrics, such as door-to-needle (DTN), door-to-imaging (DTI), imaging-to-needle (ITN), door-to-groin and door-to-recanalization times. Safety outcomes comprised rate of any intracranial hemorrhage (ICH), symptomatic ICH (sICH), parenchymatous hematoma type 2 (PH 2) and post-thrombolysis angioedema. A semiquantitative questionnaire evaluated satisfaction with TNK and changes in lysis behavior among nurses and physicians 3 months post-implementation.
Results
During the twelve-month period (December 1, 2023 - November 30, 2024), 276 patients underwent IVT. Median DTN times were significantly shorter with TNK ( n = 138) compared to rt-PA ( n = 138) (TNK 27 min [IQR 19–39] vs. rt-PA 34 min [IQR 25–62]; p = 0.011). No significant differences were observed in safety outcomes, including any ICH (TNK 9% vs. rt-PA 6%; p = 0.30), sICH (2% vs. 1%; p = 0.31), PH 2 rates (1% in both groups), or angioedema (3% vs. 1%; p = 0.18). Staff satisfaction with TNK was high, citing advantages in preparation, administration, and time efficiency. Importantly, no changes in lysis behavior were reported following the transition.
Conclusions
Transitioning to TNK in routine practice at a tertiary care center seems feasible with reduced ITN and consequently DTN times. Functional outcomes at discharge were comparable without significant difference in the rate of (s)ICH. Overall, the transition to TNK was well-received by medical staff, highlighting TNK’s practical advantages in acute stroke care.
Trial registration
N.A.
... Notably, ischemic stroke is generally considered to be a disease highly associated with aging and is often regarded as a disease of the elderly [3]. However, existing burden estimates often rely on analyses of the entire age range population [4][5][6][7][8], it may obscure the disproportionate impact on older adults. Critically, we posit that such broad age group analyses systematically underestimate ischemic stroke's true burden in aging population. ...
Background
Ischemic stroke is an important public health problem. However, comprehensive data on its burden in aging populations is limited. The aim of this study is to provide an up-to-date assessment of the prevalence, incidence, mortality, disability-adjusted life years, and risk factors for ischemic stroke globally in adults aged 60 years and older from 1990 to 2021 based on population changes.
Methods
The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 served as the data source for this study. Average annual percentage changes were estimated over the study period to quantify temporal patterns and assess trends in age-standardized rates of the prevalence, incidence, mortality, and disability-adjusted life-years of ischemic stroke.
Results
The significant increase in the prevalence and incidence of ischemic stroke is mainly related to population ageing and the significant increase in the number of people over 60 years of age, with the significant increase in the population over 60 years of age being the main driving force, while epidemiological changes have had the opposite effect. Critically, using the entire age population for calculations will prompt us to underestimate the burden of ischemic stroke. The burden of ischemic stroke disease is highest in older men than in older women, and the age-standardized prevalence rates, incidence rates, mortality rates, and disability-adjusted life-years rates are 26–35% higher in men than in women. High-middle sociodemographic index and Sub-Saharan Africa regions suffer the heaviest burden. Ischemic stroke health inequities widen, with less developed regions bearing a heavier ischemic stroke burden and the disparity in that burden becoming more pronounced over time.
Conclusion
Population aging is the primary driver of the growing burden of ischemic stroke. Our findings indicate that prevention and control of this disease remain critical public health challenges. Targeted interventions addressing modifiable risk factors could significantly reduce the global burden of ischemic stroke.
... Stroke and spinal cord injury (SCI) are leading causes of disability worldwide. Over 101 million people have experienced a stroke, and more than 15 million people are currently living with SCI [1,2]. These conditions often result in motor impairments, such as muscle weakness in the arms, hands, trunk, or legs, and loss of balance and coordination. ...
Background
There is a growing interest in exploring industrial-grade collaborative robots (cobots) for rehabilitation. This review explores their application for motor rehabilitation of the upper and lower extremities after a stroke and spinal cord injury (SCI). The article highlights the inherent safety features of cobots, emphasizing their design advantages over custom-built or traditional rehabilitation robots in terms of potential safety and time efficiency.
Methods
Database searches and reference list screening were conducted to identify studies relating to the use of cobots for upper and lower extremity rehabilitation among individuals with stroke and SCI. These articles were then reviewed and summarized.
Results
Thirty-three studies were included in this review. The findings suggest that the use of cobots in motor rehabilitation is still in the early stages. Some of the cobots used were equipped with sensors to detect and respond to the movement of the extremities and minimize the risk of injury. This safety aspect is crucial for patients with motor impairments. Most training protocols implemented with the cobots engaged users in repetitive task-based exercises with an overall positive user experience. Thus far, these devices have been primarily evaluated in individuals with stroke and SCI that affect the lower extremities, with no study addressing upper extremity impairments. This initial focus serves as a preliminary step toward assessing their applicability for individuals with stroke and SCI.
Conclusions
Cobots may have the capacity to transform therapy and support healthcare professionals in delivering more personalized and effective rehabilitation. However, there is limited evidence on their use to support upper and lower extremity rehabilitation among individuals with stroke and SCI. Further research and development are needed to refine these technologies and broaden their applications in rehabilitation settings to enhance functional recovery and overall quality of life for individuals with stroke and SCI.
... Stroke is the second leading cause of death, the third leading cause of combined death and disability, and one of the main causes of adult dementia among non-communicable diseases worldwide [1,2]. Globally, over 12.2 million new strokes are reported each year, and around one in four adults over the age of 25 will suffer a stroke in their lifetime [1]. ...
... As the population ages, stroke prevalence is expected to increase. Of all strokes, ischaemic stroke is the most common type, accounting for 80-90% of cases, with the highest proportion occurring in high-income countries [1,2]. ...
Ischaemic stroke is the most prevalent stroke subtype, accounting for 80–90% of all cases worldwide, and remains a leading cause of morbidity and mortality. Its pathophysiology involves complex molecular cascades, with oxidative stress playing a central role. During cerebral ischaemia, reduced blood flow deprives neurons of essential oxygen and nutrients, triggering excitotoxicity, mitochondrial dysfunction, and excessive production of reactive oxygen and nitrogen species (RONS). Not only do these species damage cellular components, but they also activate inflammatory pathways, particularly those mediated by the transcription factor nuclear factor kappa-B (NF-κB). The pro-inflammatory milieu intensifies neuronal damage, compromises blood–brain barrier integrity, and exacerbates reperfusion-induced damage. Recent findings highlight the importance of the gut microbiota in modulating stroke outcomes, primarily through metabolic and immunological interactions along the gut–brain axis. Dysbiosis, characterised by reduced microbial diversity and an imbalance between beneficial and harmful strains, has been linked to increased systemic inflammation, oxidative stress, and worse prognoses. Specific gut-derived metabolites, including short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO), appear to either mitigate or intensify neuronal injury. SCFAs may strengthen the blood–brain barrier and temper inflammatory responses, whereas elevated TMAO levels may increase thrombotic risk. This narrative review consolidates both experimental and clinical data demonstrating the central role of oxidative stress in ischaemic stroke pathophysiology and explores the gut microbiota’s ability to modulate these damaging processes. Therapeutic strategies targeting oxidative pathways or rebalancing gut microbial composition, such as antioxidant supplementation, dietary modulation, probiotics, and faecal microbiota transplantation, present promising paradigms for stroke intervention. However, their widespread clinical implementation is hindered by a lack of large-scale, randomised trials. Future efforts should employ a multidisciplinary approach to elucidate the intricate mechanisms linking oxidative stress and gut dysbiosis to ischaemic stroke, thereby paving the way for novel, mechanism-based therapies for improved patient outcomes.
... About 10%-30% of all ischemic stroke cases are related to atrial fibrillation (AF) [1][2][3]. Compared with strokes of other subtypes, AF-related ischemic stroke presents with distinct features, including multiple and bilateral cerebral infarcts, larger infarct volumes, and a greater propensity for hemorrhagic transformation (HT) [4,5]. This condition, a common and severe neurological complication, is linked to higher mortality rates in ischemic stroke patients [6]. ...
Background
Hemorrhagic transformation (HT) is a critical complication in acute ischemic stroke (AIS) patients with atrial fibrillation (AF) awaiting anticoagulation reinitiation. No reliable predictive model exists for assessing HT risk for these patients. Clinical decisions typically rely on NIHSS score and infarct size; however, other relevant risk factors remain insufficiently explored. This study aimed to develop and validate a predictive model for assessing the risk of HT in AIS patients with AF from stroke onset to anticoagulation therapy reinitiation.
Methods
This retrospective study included AIS patients with AF from two comprehensive medical centers in China. The primary outcome was HT postinfarction confirmed with CT/MRI before anticoagulation reinitiation. Significant predictors were identified via LASSO regression in the training set, followed by multivariable logistic regression for developing a predictive model and generating the nomogram. Model performance was validated in a separate external cohort.
Results
In the training cohort (n = 629), 174 patients (27.7%) developed HT. LASSO logistic regression revealed that infarct size, NIHSS score, diabetes mellitus, reperfusion therapy, left ventricular ejection fraction, and prehospital antihypertensive treatment were significant HT predictors. In the external validation cohort (n = 236), 61 patients (25.8%) developed HT. The nomogram exhibited strong predictive performance, with AUCs of 0.720 in the training set and 0.747 in the validation set.
Conclusions
The proposed nomogram offers a practical tool for predicting HT risk in AIS patients with AF before anticoagulation reinitiation, potentially supporting informed clinical decision‐making, though further validation is required.
... Therefore, this study integrates GBD 2021 data with APC modeling, ARIMA forecasting, exponential smoothing, and frontier analysis to conduct a comprehensive temporal assessment and prediction of the ASD burden. This multi-method, advanced analytical approach offers a deeper understanding of historical changes and future trends in ASD burden and provides novel evidence to inform public health policies at both global and regional levels (23). ...
Background
The Sustainable Development Goals (SDGs) call for systematic monitoring to optimize child development outcomes. As a developmental disorder affecting children and adults, Autism Spectrum Disorder (ASD) not only impacts individual social functioning but also places a burden on families and society. A detailed analysis of the latest global burden data on ASD can assist stakeholders in formulating support policies and interventions, thereby helping to meet the health needs of ASD.
Methods
We used data from the Global Burden of Disease Study 2021 (GBD 2021), compiled by the Institute for Health Metrics and Evaluation (IHME). Data were obtained through the Global Health Data Exchange (GHDx) and covered 204 countries and territories from 1990 to 2019. Variables included ASD-related prevalence, mortality, disability-adjusted life years (DALYs), age-standardized rates, and the sociodemographic index (SDI).
Results
Exposure to autism spectrum disorders contributed to 61823540 prevalence and 11544038 DALYs globally in 2021. Males and younger adults were high-risk populations. Higher socio-demographic index (SDI) regions were high-risk areas. The disease burden varied considerably across the GBD regions and the countries. From 1990 to 2021, the number of cases increased. The predicted results showed that the disease burden for both genders would still increase from 2022 to 2046. Countries or regions with a higher SDI have greater burden improvement potential.
Conclusion
The global burden of ASD has shown a continuous upward trend, with some differences observed across gender, age groups, and SDI regions. In terms of gender, the burden of ASD among females may be underestimated. Regarding age groups, the aging process has highlighted the urgent need to address ASD in the elderly population. High-SDI regions should place greater emphasis on improving diagnostic methods and implementing precise interventions, while middle- and low-SDI regions should focus on raising public awareness and enhancing screening capabilities.
... Globally, stroke is the third leading cause of death and the fourth leading cause of disability-adjusted life years (DALYs), accounting for 7.3 million deaths and 160.5 million DALYs in 2021 (1). Mortality and DALYs from stroke are projected to increase by 50% and 31% by 2050, with more than 90% of the deaths occurring in low-and middle-income countries (LMICs), particularly in sub-Saharan Africa (SSA) (2). ...
Introduction: Stroke is a leading cause of morbidity and mortality globally, with Africa bearing a disproportionately high burden of poor outcomes. In sub-Saharan Africa, acute stroke care remains inconsistent, with organized stroke units being either absent or rarely available, contributing to the high stroke mortality rates
in the region. To address this issue, the Tanzania Stroke Project (TSP) was launched, aimed at establishing acute stroke services at two of the largest tertiary care centers in collaboration with the Tanzanian Ministry of Health, the World Stroke Organization and Hospital Directorates.
Methods: TSP utilized a three-tier implementation approach to establish a more organized stroke care system in two large academic hospitals. Here, we detail the process of this initiative, which took place between August 2023 and August 2024. The three-tier approach included: 1) The establishment of stroke registries; 2) The training of healthcare workers (HCWs); and 3) The development of acute stroke protocols and establishment of stroke units at Muhimbili National Hospital-Mloganzila and Bugando Medical Centre in Tanzania.
Results: Tier one (Stroke registry): Two comprehensive stroke registries were established, including 460 adults (mean age 60±15years). Hemorrhagic stroke was the most common subtype, accounting for 59% of cases (n=269). Premorbid hypertension was the most prevalent risk factor, affecting 81% (n=373) of the patients. More than half of patients (58%, n=171) arrived at the hospital after 24 hours from stroke symptoms. Only 11% (n=50/452) had documented swallowing screenings, and among patients with intracerebral hemorrhage, 11% (n=28/251) achieved the target for blood pressure control, while 47% (n=99/213) met blood glucose control targets. The in-hospital mortality rate was 27% (n=93/340). Tier two (Training of HCWs): Extensive evidence based mentorship training was provided with higher participation rates among HCWs at Bugando Medical Centre compared to Muhimbili National Hospital-Mloganzila (57% (29/51) vs. 23% (7/31), p=0.002). Tier three (Stroke unit protocols): Stroke protocols were developed based on the training and current evidence; leading to the establishment of dedicated stroke units at each facility, with a minimum of 8 beds per unit. The full impact of these implementations has yet to be fully assessed.
Conclusion: This was the first initiative to implement stroke services at two large tertiary healthcare centers in Tanzania. Our findings highlight the importance of multi-level stakeholder engagement through a 3-tier approach in countries starting to establish stroke services and the need for ongoing quality-of-care monitoring and
continuous efforts to sensitize both HCWs and the broader community.
